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Best friends Steven Craven and Nico Bradley inexplicably run away from home and travel to Mexico. They film themselves engaging in several days' worth of drunken partying. The boys disappear, and the mexican authorities ultimately turn over their belongings to their parents, including a videotape made by Steven that apparently documents their final moments.</p>

A year later, Steven's family—parents Ross and Sarah, and sister, Emma—gather for dinner with Nico's parents, Peter and Kate. Tensions raise when Emma, who had been dating Nico, demands that the families acknowledge the news that a private investigator was unable to turn up any evidence of the boys' fates. Emma questions her mother about the contents of Steven's camera, which she has been obsessively watching in private. Later, Emma sneaks into Steven's room and finds the camera. Watching the video, she finds footage documenting Steven and Nico picking up a girl in a bar. A flashback along with the camera footage shows that Nico casually murdered her while having sex in a stall in the bar's restroom, and that Nico later blackmailed Steven into continuing on their "vacation" together by threatening to implicate him in the crime.

Continuing to go through Steven's things, Emma also finds a gold and black puzzle box visible in the final moments of the video. Playing with it causes Steven to materialize out of thin air, covered in blood that does not appear to be his own. The families prepare to rush him to the hospital, only to discover that all of the vehicles have disappeared from the driveway. Attempting to dial 911, they discover that the land lines and cell phones are receiving interference and no outgoing calls can be made. As they are four miles away from the nearest main road and it is the middle of the night, they decide to wait until morning and then seek help. Steven tells the families that he has escaped "The Cenobites," a word that Emma defines as members of a monastic community.

Another flashback shows Steven and Nico sitting in a bar when they are approached by a Vagrant who seems to know about the murder of the girl and offers them the puzzle box, telling them that it will expand their horizons of sensual pleasure and allow them to experience physical and psychological states of euphoria inaccessible to most people. When Nico attempts to buy it from him, the Vagrant gives it to him, telling him that the box has "always" been his.

In the present, Emma plays with the puzzle box again, causing her to experience intense arousal. After coming on to Nico's father she brings soup to her brother and the two have an intensely close conversation about Emma's sexual maturation, culminating in the two passionately kissing and fondling one another. As Steven caresses her breast, Emma has a vision of a realm filled with chains and mutilated bodies.

Steven comes downstairs, retrieves the shotgun, and after shooting Ross in the stomach holds everyone at gunpoint.

A final flashback reveals that after Nico opened the puzzle box, he accessed the realm of the Cenobites, extra-dimensional sadomasochists led by Pinhead, who offered him the ultimate experience. While Steven fled, Nico agreed, and was taken to the Cenobite's realm to be subjected to extreme torture and mutilation. Sometime later, Steven's having rough sex with a prostitute near the box allowing Nico to communicate with him, begging him to kill her. Steven bludgeoned the woman to death with the box, the resultant blood giving Nico enough energy to escape the Cenobite realm as an emaciated, skinless monster. Now pursued by the Cenobites, Nico needs more blood to reinvigorate himself. For an indeterminate amount of time, Steven hires prostitutes and then murders them, feeding their blood to Nico; Nico's body slowly regenerates until all he needs is human skin. When Steven refuses to kill anymore, after Nico kills a woman and her baby, Nico attacks and skins him, putting on Steven's flesh as a "suit." As Nico leaves, the dying Steven grabs the puzzle box and summons up the Cenobites; they accept him into their ranks and transform him into a partially skinned creature similar to Pinhead, with nails driven into his skull.

Nico taunts the families with the shotgun before finally demanding that Emma retrieve and open the puzzle box for him: Having lived in fear of the Cenobites for so long, he intends to offer up Emma to take his place in their realm, thus ensuring his own freedom.

Emma opens the box at gunpoint and the Cenobites—including Steven—appear. Pinhead recognizes in Emma a dark sexual desire and taunts her with innuendo. Kate, ignoring Pinhead's admonition to remain silent, tells Pinhead that it was in fact Nico who forced Emma to open the box, causing Pinhead to send chains to rip open her throat. When Nico offers Emma as his replacement, Pinhead refuses. Instead, chains emerge from the walls, ensnaring Nico. As the Cenobites prepare to leave, the dying Ross shoots Nico in the chest, declaring that only he should have the satisfaction of revenge. An angry Pinhead tells him that the tortures the Cenobites would have enacted on him should have been revenge enough, and that they are now bereft a victim. Chains emerge from the walls and ensnare Sarah, as Pinhead tells Ross that he will die knowing that his own need for vengeance has caused his wife an eternity of torment. Before leaving he tells Emma that when this existence no longer satisfies her they will be waiting for her.

Pinhead, the Cenobites, and Sarah all vanish. Ross apologizes for everything he's done before dying in Emma' arms. Emma reaches out for the puzzle box as the movie ends.